The Lapidus procedure is a surgical procedure used to treat a bunion deformity, also known as hallux valgus. It involves fusing the joint between the first metatarsal bone and one of the small bones in your midfoot called the medial cuneiform. Surgery includes removing the cartilage surfaces from both bones, correcting the angular deformity, then placing hardware (screws and/or a plate) to allow the two bones to grow together, or fuse.
Your foot and ankle orthopaedic surgeon may perform this procedure to correct a mild or severe bunion deformity, or when there is too much motion through the tarsometatarsal (TMT) joint. When the TMT joint has too much looseness or movement, the condition is known as hypermobility or instability. This causes the first metatarsal to move too far in one direction or rotate abnormally, and the big toe compensates by moving too much toward the second toe. When this happens, a bunion can develop.
The goal of the Lapidus procedure is to surgically fix the bunion by removing the TMT joint and repositioning the bones of the big toe to straighten it. When the first TMT joint is fused, the first metatarsal will not move abnormally. This will allow the first toe to stay straight and decrease the risk of the bunion coming back.
Signs surgery may be needed include:
The Lapidus procedure is an outpatient procedure, meaning the patient can go home the same day as surgery. Surgery is performed under general anesthesia so the patient is fully asleep or a nerve block is used.
The Lapidus procedure often is one part of bunion correction surgery. Once your foot and ankle orthopaedic surgeon removes the large bony prominence near the big toe, they turn their attention to the TMT joint. They will remove the cartilage surfaces of each bone, correct the alignment, and compress the bones together with hardware. This may be screws or a combination of a plate with screws.
Once the Lapidus is completed, an additional procedure may be necessary to complete the correction of the bunion deformity.
Before (left) and After (right) X-rays of a patient undergoing a Lapidus procedure to correct a bunion deformity of the left foot. The arrow points to the base of the big toe where the bunion sticks out from the foot.
Patients typically are immobilized in a splint or boot for the first two weeks after surgery to allow for the incisions to heal. They often are restricted from putting full weight on the foot. Patients can use crutches or a walker to help stay off the foot after surgery.
Around six weeks after surgery, patients progress to full weightbearing in either a boot or post-op shoe, then slowly transition to regular shoes over time.
Some residual swelling and discomfort is normal up to a year after surgery. Most patients are able to return to normal activities with minimal pain and/or problems by 4-6 months after the surgery.
A successful Lapidus procedure should allow you to walk or run with minimal problems or pain once you are fully recovered.
Your surgeon will ask you to limit your weight bearing for several weeks in order to prevent movement between the first metatarsal and medial cuneiform bones that are trying to fuse together. If there is too much motion between the bones, it can take longer for them to heal or they may not heal at all. Typically, bones take 6-8 weeks to heal, so you must limit weight bearing during that time.
When bones do not heal together the condition is called a nonunion. Patients who are diabetic or smoke are at higher risk for having this problem. This can also happen if patients put too much weight on the foot before the bones have a chance to fuse together. The most common symptom of a nonunion is continued pain after surgery. X-rays may show broken hardware, which suggests that there is still movement at the fused joint. Most nonunions need further surgery to achieve healing.
Original article by Nicholas Cheney, DO
Contributors/Reviewers: Patrick Maloney, MD; David Porter, MD, PhD; Sudheer Reddy, MD
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